Consumer Loan Application

LOAN REQUEST

*Purpose of Loan

*Amount Requested

*Months Needed

PERSONAL INFORMATION

This application is designed to be completed by the applicant(s) with the lender's assistance.
The Co-Applicant section and all other Co-Applicant questions should be completed to the extent possible if: (1) co-applicant will be jointly obligated with you on the loan; (2) you will be relying on income or assets of the co-applicant as a basis for repayment of the loan; (3) you are relying on income from alimony, child support, or separate maintenance from the co-applicant or other party; or (4) you are married to the co-applicant and reside in, or the property is located in, a community property State. If you are married, your spouse need not be jointly obligated with you on the loan and need not sign as a co-applicant unless item (2) above applies or unless the spouse's signature is required under state law to create a valid lien, pass clear title or waive inchoate rights to property.

APPLICANT

*Full Name

*Date of Birth

*Present Address

*City, State Zip

,

*Rent or Own

Rent
Own

*Years at address

*Phone Number

*Email Address

Previous Address (complete if less than 2 years at present address)

*City, State Zip

,

*Social Security Number

Employer Name

How Long?

Position/Title

Previous EmployerComplete if current job held less than 2 years

How long

Position/Title

Are there any unsatisfied judgments against you?

Yes
No

In the last 7 years, have you been declared bankrupt?

Yes
No

Did you ever have credit in any other name?

Yes
No

If yes, what name?

CO-APPLICANT

Full Name

Date of Birth

Present Address

City, State Zip

,

Rent or Own

Rent
Own

Years at address

Phone Number

Previous Address (complete if less than 2 years at present address)

City, State Zip

,

Social Security Number

Employer Name

How Long?

Position/Title

Previous EmployerComplete if current job held less than 2 years

How long

Position/Title

Are there any unsatisfied judgments against you?

Yes
No

In the last 7 years, have you been declared bankrupt?

Yes
No

Did you ever have credit in any other name?

Yes
No

If yes, what name?

Assets

DEPOSITS IN CHECKING & SAVINGS ACCOUNTS

Amount/Value

Name of Institution

Type

Account No.

Applicant

Co-Applicant

$

$

$

$

$

$

Vehicles

List/Make

Year

Fully Paid.

Applicant

Co-Applicant

Yes
No

$

$

Yes
No

$

$

Yes
No

$

$

Real Estate Owned

Description

Applicant

Co-Applicant

$

$

$

$

TOTAL ASSETS

TOTAL ASSETS

$

$

INCOME

Monthly Income

Applicant

Co-Applicant

Gross Base Earnings

$

$

Overtime

$

$

Bonuses-Comissions

$

$

Other-Optional-See Remarks

$

$

Income Remarks - Note: Income from Alimony, Child Support or Maintenance Payments need not be disclosed if you do not wish to have it considered as a basis for Repaying this obligation.

By clicking submit, I declare and represent that I have read the foregoing Application, that all statements made therein are complete and true to their knowledge, that all financial and credit information of value to the consideration of this Loan Request has been given that the statements are made and information given as an inducement to the Lender to grant the Loan for which this Application is made. The Applicant(s) authorize the Lender, or his Agent, to verify the information contained herein and to make such additional normal inquiries information, along with this Application, shall remain the Lender's property.
I undersigned understand that the selection of a dealer or contractor is their responsibility and that this financial institution in no way guarantees equipment, materials or workmanship and that it is a federal crime punishable by fine or imprisonment or both to knowingly make any false statements concerning any of the above facts, as applicable under the provisions of Title 18, United States Code, Section 1014.